Code crisis – morale at Bunbury Regional Hospital | AMA (WA)


Bunbury hospital

Code crisis – morale at Bunbury Regional Hospital

Friday April 23, 2021

A ruptured relationship between doctors and WACHS Senior Executive has triggered a pressure cooker situation at Bunbury Regional Hospital.

“WACHS remains absolutely committed to improving our engagement and culture, and recognises that employee satisfaction is integral to our mission of delivering and advancing high quality healthcare in country WA.” WA Country Health Service (WACHS), November 2019.

This quote from WACHS about its overall intent to improve general communications with its medical workforce was in response to the Minister for Health’s Your Voice in Health (YVIH) survey results.

It appears WACHS’ commitment doesn’t extend to staff at Bunbury Regional Hospital (BRH).

A recent AMA (WA) survey of doctors at the WA Health-operated hospital reveals defective communication pathways between WACHS senior executives and clinicians, and a pervasive fear amongst doctors when it comes to raising concerns with management.

The Bunbury Regional Hospital Clinical Engagement and Morale Survey exposed other equally alarming issues, with scores eclipsing all previous AMA (WA) surveys to date.

The results reveal an utterly disengaged clinical workforce that feels subjected to dangerous levels of intimidation and disregard by the WACHS senior executive, all at the expense of patient safety and employee wellbeing. These issues were all previously raised directly with WACHS’ Board Chair and the Director General of WA Health.

In both AMA (WA) system-wide senior doctor engagement and morale surveys (2017 and 2019), WACHS twice produced some of the lowest scores. Equally concerning is the fact that WACHS was one of two health service providers (HSPs) to report a deterioration in results for some key measures in the 2019 survey.

The 2020 Minister’s YVIH engagement survey reported some improvements for WACHS medical practitioner results, when compared to 2019 data. WACHS Chief Executive Jeff Moffett lauded the progress and pointed to the increase in the survey’s Employee Engagement Index for WACHS doctors, noting: “WACHS will continue focusing attention on improving staff recognition, collaboration, communication and wellbeing”.

What stood out for the AMA (WA), however, was the small number of medical practitioners from WACHS who completed the 2020 YVIH survey – a mere 68 doctors from more than 650 potential respondents. This marked a 70 per cent reduction in WACHS medical practitioner responses, compared to the 2019 survey.

While WACHS engagement and morale ratings remain a concern, BRH is, without doubt, an exposed nerve. The AMA (WA) has received numerous calls from clinicians at the hospital, reporting adversarial bureaucratic intervention, poor decision-making and a lack of engagement from management. More often than not, the managerial approach is one the AMA (WA) would characterise as disingenuous, opaque and punitive.

No contract, no reason

Any review of the ongoing issues at BRH would be piecemeal without mention of the catalyst that triggered a great deal of concern and fear amongst the doctors at the hospital.

On 30 September 2020, long serving and much-admired head of BRH’s emergency department, Dr Adam Coulson, was advised his contract would not be renewed. He was offered no alternatives or any meaningful reason for the decision, which sent a frisson of alarm through the entire hospital. The non-renewal of Dr Coulson’s contract occurred despite him receiving good formal performance reports (the last taking place mere weeks before) and multiple verbal assurances from senior managers that his contract would be renewed.

No less than 43 staff specialists engaged at BRH contacted the AMA (WA) independently to express their profound lack of trust and confidence in WACHS Executive as a result of Dr Coulson’s experience.

Those same sentiments are echoed in the ‘comments’ section of the recent AMA (WA) survey.

One doctor wrote: “It is an absolute travesty that this natural leader and extremely talented emergency physician is losing his tenure.”

Another said: “A critical safety issue is currently staff’s fear to speak up. Our most vocal spokesperson was essentially dismissed without any transparency, leading staff to assume that it may be related to his advocacy for patient and staff safety.”

Yet another colleague referred to BRH doctors being fearful of saying things that management didn’t want to hear. “The phenomenon of Heads of Department across WACHS being told their contracts won’t be renewed has a chilling effect on the exercise of leadership,” they wrote.

AMA (WA) President Dr Andrew Miller raised the arbitrary non-renewal of Dr Coulson’s contract in a letter to WACHS Chair Dr Neale Fong in December 2020.

The need for a survey

Following a lacklustre response to concerns raised by the AMA (WA) at several levels of WACHS leadership and the clinicians themselves, we felt compelled to survey BRH doctors in an effort to clearly identify issues that exist at the hospital and the degree to which they exist. The aim was to elicit a meaningful response to these issues from WACHS, the Director General of WA Health and the WA Government, and to address the problems besieging the hospital.

Fifty-six doctors at BRH participated in the AMA (WA) survey – a high proportion of BRH’s clinical workforce, almost matching the total number of all WACHS medical respondents to the 2020 YVIH survey. The next few pages present some of the results, which tell a tale of disquiet and utter despondence.

Employee wellbeing is overwhelmingly identified as being negatively impacted by workplace culture and morale. Equally concerning is the reported negative impact on clinical outcomes, identified by a large majority of respondents.

Fear of victimisation as a result of raising concerns about decisions taken by senior executive is pervasive. Through Dr Coulson’s example, BRH doctors have witnessed firsthand the impact of questioning senior executive decisions, and consequently are concerned about the future impact of such action on their employment.

Word from the wards

The AMA (WA) independently contacted two doctors – one a senior consultant, the other, an RMO – both of whom prefer to remain anonymous.

According to the junior doctor, there are several positives to working at BRH.

“Bunbury Hospital is privileged to have a large cohort of senior clinicians and heads of department who place a large emphasis on teaching and junior doctor welfare.”

They acknowledged, however, that improvements were needed in communication between consultants and junior doctors, the payment of overtime and provision of formal teaching.

They also pointed to the ED as a particular minefield. “A number of consultants have handed in their notice because they’re unhappy with the loss of a great head of department in Adam Coulson, or their contracts haven’t been renewed. This seems absurd given the department is permanently short-staffed, reliant on locum registrars and consultants to fill a deficit. No help from WACHS with new contracts or a staff drive appears to be at hand.”

The RMO recognised that steps have been taken to improve these situations, with permanent executive staff on long-term contracts, and a fully staffed medical workforce on site who have done an exceptional job at picking up the pieces of last year. However, the aftershocks are still being felt.

“Multiple departments are short staffed, and leave is hard to come by, with a reduced cohort of juniors available on leave relief terms,” they explained.

The senior consultant we approached also acknowledged the loss of Dr Coulson as having had a devastating effect on morale in the ED and the hospital as a whole.

“Senior clinicians have been left wondering if their jobs are secure and feeling that they can no longer ‘speak up for safety’,” they said.

“As senior clinicians, our focus is on offering excellent care for our patients, while also providing education, support and mentoring for the others with whom we work.

“The flow-on effect on the morale of senior clinicians has been immense. All staff in the ED have been impacted by the recent events and keenly feel the loss of a respected leader.

“A number of consultants have chosen to leave, or reduce their hours. Junior medical staff throughout the hospital have also expressed concerns about their ongoing commitment to WACHS.

“We are left wondering – where is the patient in all this?”

The way forward

The AMA (WA) strongly believes that the unreasonable flexing of contract renewal muscle and continued inaction and neglect by WACHS has brought doctors at BRH to their knees. Given the deleterious survey results and the consequent risk to patient outcomes and employee wellbeing, the Association:

  • has reported WACHS to WorkSafe WA, seeking a health and safety investigation
  • is calling for the establishment of alternative pathways for BRH staff to raise and communicate safety concerns
  • will liaise with the WACHS Board, communicating our concerns and survey results, and seeking transparency and accountability in relation to recent decision-making and immediate action to address the systemic communication and engagement issues at BRH. This is in addition to action to demonstrate to staff at BRH that destructive bureaucratic decision-making cannot happen again; and
  • will communicate the issues at BRH to Premier Mark McGowan, Health Minister Roger Cook and WA Health DG Dr David Russell-Weisz to once again illustrate the damaging impact of five-year contracts on doctors’ wellbeing and service delivery. An active and genuine commitment to support clinical engagement and workforce wellbeing is needed.

Representing WA’s medical profession, the AMA (WA) stands willing to work together with management at BRH, WACHS Senior Executive, and the State Government to improve engagement and culture at the hospital and drive constructive change.

Get the full story, the survey results and comments from BRH doctors here (extract from Medicus magazine).